title: Evaluation of an internet-based hearing test--comparison with established methods for detection of hearing loss.
abstract: BACKGROUND
  Hearing impairment is most accurately measured by a clinical pure-tone audiogram. This method is not suitable for large-scale, population-based epidemiological studies as it requires that study participants visit a clinic with trained personnel. An alternative approach to measuring hearing ability is self-estimation through questionnaires, but the correlation to clinical audiometric tests varies.
  
  
  OBJECTIVE
  To evaluate an Internet-based hearing test pilot compared to a question about self-estimated hearing and the feasibility of using an Internet-based hearing test and an Internet-based questionnaire in a population of 560 members of the Swedish Hunters' Association in the age group 20-60 years.
  
  
  METHODS
  An invitation was mailed to the participants in March 2007 together with the URL to the study Web site, a personal username, and a password. The Web site included the questionnaire, the hearing test, and instructions for participating in the study. The hearing test resembles a clinical audiogram presenting 6 tones between 500 and 8000 Hz. Tones are presented between 0 and 60 dB, and the participant responds to the tones by pressing the space bar. The hearing test requires headphones and is based on JAVA programming. Before the participant can start the hearing test, it has to be calibrated against a reference person with good hearing between 15 and 35 years of age.
  
  
  RESULTS
  After 5 months, 162 out of 560 (29%) had answered the questionnaire, out of which 88 (16%) had completed the hearing test. Those who actively declined participation numbered 230 out of 560 (41%). After removing duplicates and hearing tests calibrated by unreliable reference data, 61 hearing tests remained for analysis. The prevalence of hearing impairment from the Internet-based hearing test was 20% (12 out of 61), compared to 52% (32 out of 61) from the self-estimated question. Those who completed the hearing test were older than the non-participants, and more had headphones (P = .003) and the correct version of the JAVA program (P = .007) than those who only answered the questionnaire.
  
  
  CONCLUSIONS
  Though an Internet-based hearing test cannot replace a clinical pure-tone audiogram conducted by a trained audiologist, it is a valid and useful screening tool for hearing ability in a large population carried out at a low cost.
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-171 77 Stockholm, Sweden. Christin.Bexelius@ki.se
authors.forename: Christin
authors.initials: C
authors.lastname: Bexelius
authors.forename: Louise
authors.initials: L
authors.lastname: Honeth
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ekman
authors.forename: Mikael
authors.initials: M
authors.lastname: Eriksson
authors.forename: Sven
authors.initials: S
authors.lastname: Sandin
authors.forename: Dan
authors.initials: D
authors.lastname: Bagger-Sjöbäck
authors.forename: Jan-Eric
authors.initials: JE
authors.lastname: Litton
mesh_terms: D001299:Audiometry / Q000379:methods / Q000592:standards; D001330:Electronic Data Processing / Q000379:methods* / Q000592:standards; D005240:Feasibility Studies; D034381:Hearing Loss / Q000175:diagnosis*; D006320:Hearing Tests / Q000592:standards*; D006801:Humans; D020407:Internet; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires